Effects of obesity and gender on exercise capacity in urban children.

Background: The prevalence of childhood and adolescent obesity has been rising steadily over the last few decades and is now considered one of the most important issues worldwide.

Objective: The goal of this study was to investigate the influence of body mass on fitness in a healthy cohort of urban children and adolescents and to evaluate the difference in the cardiovascular responses, as measured by heart rate and endurance time, elicited with exercise in each gender.

Methods: This observational study was conducted in an exercise laboratory.

Simple scoring system for early management of heparin-induced thrombocytopenia.

This study was performed to develop a simple scoring system to aid in the early clinical management of patients suspected of heparin-induced thrombocytopenia (HIT) with regard to decisions for continued heparin therapy. The system was designed to arrive at low (0) or possible (1) probability scores without knowledge of laboratory test results (except platelet counts) to avoid delays. As the safest clinical approach is to discontinue heparin, intermediate and high scores were combined.

Diabetes--a silent disorder.

The earliest diagnosis of diabetes is a mandate to arrest the worldwide epidemic of diabetes. The insulin assay with the oral glucose tolerance provides the earliest diagnosis. The pathology of diabetes occurs in those with normal blood sugars.

Pediatric pulmonary arterial hypertension--a review.

Pulmonary arterial hypertension (PAH) afflicts thousands of children worldwide. The pathophysiology involves intravascular proliferation and remodeling leading to an increase in pulmonary vascular resistance which if left untreated results in right heart failure and death. Signs and symptoms are subtle as the disease progresses to irreversible lung damage.

Wine, beer, and spirits metabolism.

Comprehensive therapists regularly encounter patients consuming alcoholic beverages. It remains important that they understand how the body deals with its consumption, whether temperate and intemperate.

Alcohol consumption: benefit versus peril.

Like medication, alcohol has benefits in appropriate small doses and has perils in greater doses. Comprehensive therapists need to understand both!

Digoxin and reduction of heart failure hospitalization in chronic systolic and diastolic heart failure.

In the Digitalis Investigation Group trial, digoxin-associated decrease in the combined end point of heart failure (HF) hospitalization or HF mortality was significant in systolic but not in diastolic HF. To assess whether this apparent disparity could be explained by differences in baseline characteristics and sample size, we used propensity score matching to assemble a cohort of 916 pairs of patients with systolic and diastolic HF who were balanced in all measured baseline covariates. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of the effect of digoxin on outcomes separately in systolic and diastolic HF, at 2 years (protocol prespecified), and at the end of 3.

A brief history of scientific geriatric cardiology.

Comprehensive therapists need awareness of the long period of neglect of the elderly cardiac patient, its improvement in the last third of a century, and a look to the future.

Human sexual intercourse.

The comprehensive therapist needs to view human sexual intercourse comprehensively to avoid its hazards and to promote its benefits for all patients.

Pulmonary arterial hypertension.

Better recognition of primary pulmonary hypertension can produce better treatment by comprehensive therapists.

The classical vs nonclassical NSAIDs: can the reduction in pain overcome the thrombotic risk?

The advent of cyclooxygenase-2 inhibitors has been both a blessing and a curse for pain management. An in-depth understanding of the biological molecules in the arachidonic acid metabolism may alleviate pain without risk.

Pain, analgesics, and the cardiovascular system.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most used medications in the world. Ordinarily considered to be safe and effective when used according to labeling instructions, their safety for patients with cardiovascular disease is now being reassessed.

Effects of discontinuation of digoxin versus continuation at low serum digoxin concentrations in chronic heart failure.

Discontinuation of digoxin is associated with worsening heart failure (HF) symptoms. However, the long-term effects of discontinuation of digoxin therapy on mortality and morbidity in HF have not been well studied. Of the 7,788 participants in the Digoxin Investigation Group trial, 3,365 received digoxin before randomization.

Porphyria syndrome associated with diabetic nephrosclerosis and erythropoietin.

The porphyrias are inherited or acquired metabolic disorders caused by a partial deficiency in one of the enzymes of the heme biosynthetic pathway. Eight enzymes are utilized in the synthesis of heme. An enzyme defect in one of the last seven enzymes will result in one of the seven different forms of porphyria, some of which have similar signs and symptoms.

Unstable angina treatment: 2006 update.

Properly treated, unstable angina and non-Q wave myocardial infarction have low hospital mortality, but if untreated, mortality is high. Symptoms and labs usually suffice for diagnosis. Abnormal physical findings are rarely helpful and often absent.

Thromboembolism in cancer patients: pathogenesis and treatment.

In this review we summarize the causes of cancer related thrombosis as well as modern treatment approaches. Malignancy as a risk factor for thromboembolism is becoming increasingly recognized by clinicians caring for these patients. The probability of thrombosis occurring in an individual patient is dependent on several factors, including accompanying medical problems, the type of cancer, the clinical stage, performance status, and the treatment modalities employed.

Antithrombotic agents in the treatment of severe sepsis.

Sepsis, a systemic inflammatory syndrome, is a response to infection and when associated with multiple organ dysfunction is termed severe sepsis. It remains a leading cause of mortality in the critically ill. The response to the invading microorganisms may be considered as a balance between a pro-inflammatory and an anti-inflammatory reaction.

A woman's body and her vascular system are unique. How should we care for them?

Women must now gain the phenomenal care justified by new biologic evidence and a comprehensive understanding of fundamental differences from men-that go well beyond secondary sexual characteristics.

Antiplatelet agents: current drugs and future trends.

Antiplatelet drugs in clinical use are discussed in terms of their mechanisms of action and the relevancy of that to the physiology of platelets and the pathophysiology of arterial thrombosis. Current clinical usage is outlined in detail for each drug. Experimental antiplatelet drugs also are discussed.